Gastrointestinal perforation in infants: cases unrelated to necrotizing enterocolitis

From January 1984 to March 1992, there were 19 infants admitted to our hospital with gastrointestinal perforation not associated with necrotizing enterocolitis. Seven patients (37%) were premature. Six patients (32%) had their perforations located in the stomach, 9 (47%) in the small intestine, and 3 (16%) in the colon. The most common clinical presentation was abdominal distention (95%). Pneumoperitoneum was noted only in 12 (63%) patients. About 60% of the patients had the perforation occur before 4 days of age. The predominant cause of perforation was unknown, so called spontaneous perforation (8/19, 42%), followed by ischemia or infarction (5/19, 26%). The overall mortality rate was 32%. The non-survivors had more severe metabolic acidosis than the survivors, but there were no differences in the birthweight and gestational ages of these two groups. Sepsis accounted for 83% of the deaths. Early diagnosis and treatment are the best ways to promote survival.